Provider Demographics
NPI:1366476921
Name:ORFANOS, JOHN G (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:ORFANOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2975
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-2975
Mailing Address - Country:US
Mailing Address - Phone:956-362-8170
Mailing Address - Fax:956-362-8168
Practice Address - Street 1:1100 E DOVE AVE STE 300
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:563-628-1709
Practice Address - Fax:956-362-8168
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG97802086S0127X, 2086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020047898OtherRAILROAD
TX0032PAOtherBCBS
TXP00244237OtherMEDICARE RAILROAD
TXG9780OtherTEXAS STATE BOARD OF MEDI
TX126615710Medicaid
TX126615703Medicaid
TX126615706Medicaid
TX126615707Medicaid
TX126615708Medicaid
TX126615709Medicaid
TX126615711Medicaid
TX020047898OtherRAILROAD
TX0032PAOtherBCBS
TX8F23720Medicare PIN
TX126615706Medicaid
TXP00244237OtherMEDICARE RAILROAD
TXC20066Medicare UPIN
TX126615708Medicaid